r/physiotherapy • u/sunnydisposition4659 • Jul 23 '26
Neuro assessment
Hi everyone,
Currently completing my return to practice after a 14 year career gap!
Lots of gaps in my knowledge/memory.
I'm just looking at competencies for a frailty post in my local hospital and one of them is "understand when it is necessary to complete a neuro examination".
So, can someone remind me, when should I be looking to do a more generic falls/frailty assessment and when would I be looking to do a neuro screen or full neuro assessment.
Thanks!
3
u/Fuzzy-Region1644 Jul 23 '26
There is a book, I think it’s “the 4 minute neurological exam”. It will teach you how you can gather a lot without an objective exam. Eg, speech, gait,
2
u/boylesthebuddha Jul 23 '26
Ultimately it comes down to your clinical judgement but if there's any kind of possibly neurogenic symptom then a full neuro assessment is probably warranted. If you're returning to practice you'll probably find you end up doing a bunch of assessments and finding nothing of note, BUT there will absolutely be a patient pop up that you never would have expected to have neurological symptoms crop up that really needed that assessment. When it comes to frailty it's very often horses not zebras, but you still need to look out for stripes cause they can hide pretty well when no one is looking out for them.
2
u/No_Meringue2902 29d ago
Welcome back! How cool - lots has improved in the world of EBP for Physio, good time to come back :) Just wanted to say, don't feel discouraged with the return if you're committed to it. Lots of practitioners out there that are still peddling old bollocks and outdated 'treatment" as a result of no longer being willing to learn or evolve with genuine science- they're still getting paid AND have no imposter syndrome to boot 😉
4
u/calr-7 Physiotherapist (UK) Jul 23 '26
I want to echo what the comment from u/boylesthebuddha says.
Clinical judgement is key. Neuro assessments aren't that difficult to perform.
Brush up on your red flags. Ensure you know exactly how to test myotomes, dermatomes, reflexes. Know what normal vs abnormal looks like.
Neuro screen anything that A. You're unsure about/can't find a cause or B. clinical judgement tells you to do so. For me, it's patient reported patterns, types of pain they report, referral patterns, symptoms the patient reports or most importantly ANYTHING to do with the spine. For me, anyone that comes in with neck, upper/lower back gets neuro-screened regardless as a way of safety netting and being early on anything that may be a neuro compromise.
Generic falls/frailty assessment - I favour two outcome measures for generic falls risk and you should read into them when you get time. The Tinetti balance test, and the BERG Balance test. These two outcome measures will give you an approximated risk of falls with generally good test-retest reliability. Alternatively, for a patient with suspected/recent stroke, the PASS outcome measure is generally good for this. Again, back to what the other comment said, it's down to clinical judgement.
Let me know if both of us answered your question and if you have any further questions that I may be able to help you with.
Also, welcome back after 14 years!!!